Invasive Management of Vertebrobasilar Artery Stenosis and Occlusion: A Meta-Analysis on Efficacy and Safety Endpoints

Abstract

Vertebrobasilar angioplasty and stenting or mechanical thrombectomy (MT) using a stent retriever or suction thrombectomy are effective interventions in managing acute ischemic stroke caused by vertebrobasilar artery occlusion (VBAO). This study aims to investigate the safety and efficacy of self-expanding stents and balloon angioplasty in managing ischemic stroke. We reviewed the literature for relevant clinical trials and included those reporting the following primary outcomes: successful recanalization, favorable clinical outcome, and stenosis degree change. We included 24 studies (858 patients). In the subgroup analysis, participants were divided into three main subgroups based on the type of intervention: mechanical thrombectomy (MT), percutaneous transluminal angioplasty and stenting (PTAS), and MT+PTAS. Regarding overall mortality, the incidence was 34.5%, 9.9%, and 28.9% in the MT, PTAS, and MT+PTAS groups, respectively. The incidence of arterial dissection was 3.6% in the MT group, 3.1% in the PTAS group, and 16.7% in the MT+PTAS group. Incidence of distal embolization, MT, PTAS, and MT+PTAS groups had 3.4%, 5.8%, and 9.5% incidence rates, respectively. Favorable clinical outcomes were reported in 42.8% of subjects in the MT+PTAS group, 64.7% in the PTAS group, and 39.2% in the MT group. The incidence of intracranial hemorrhage was 5.2%, 4.5%, and 15.3% in the MT, PTAS, MT + PTAS groups, respectively. The incidence of successful recanalization was 85.3% in the MT group, 99.4% in the PTAS group, and 92.7% in the MT+PTAS group. Our analysis concludes that PTAS is the most effective intervention for VBAO and is associated with a lower rate of mortality compared to mechanical thrombectomy alone.

Endovascular Approach in Treating Vertebrobasilar Insufficiency: A Systematic Review

“…As many as 25% of patients over the age of 70 may have VBI. Moreover, patients with VBI tend to have a multitude of symptoms including but not limited to ataxia, dizziness, vertigo, double vision, dysphagia, and slurred speech [ 2 ].…”

“…Therefore, obtaining an X-ray, CTA, or MRA is vital to rule out cervical pathology [ 3 ]. Besides, transcranial Doppler ultrasound, performed at the bedside, can assess the hemodynamics of the cerebral vessels if warranted in patients with VBI [ 2 ].…”

“…Therefore, obtaining an Xray, CTA, or MRA is vital to rule out cervical pathology [3]. Besides, transcranial Doppler ultrasound, performed at the bedside, can assess the hemodynamics of the cerebral vessels if warranted in patients with VBI [2]. VBI treatment is complex, and over the years, surgeons have been developing techniques and surgical approaches that are more minimally invasive, produce better outcomes with shorter operating room times, and are more cost-effective.…”

“…All the studies mentioned in the table met the inclusion criteria of this systematic review.VBI is a significant medical condition caused by the lack of adequate blood flow to the posterior circulation of the brain. It is often associated with VBA stenosis or occlusion, leading to devastating consequences such as stroke, cognitive impairment, and even death[2]. An endovascular approach has been explored as a treatment option for patients with VBI caused by stenosis or occlusion.…”